The Historical Research of Japanese Administrative Policy and Outcome of Maternal and Child Health Education

Saturday, 26 July 2014

Yukari Kawahara, PhD, RN
Department of Fundamental Nursing, The Japanese Red Cross College of Nursing, Tokyo, Japan
Atsuko Yumoto, MA, CNM
Department of Womens Health Nursing, Graduate School of Nursing,, Dokkyo Medical University, Tochigi, Japan
Kazuko Yarimizo, BS
Council for Maternal and Child Health Promotion, Tokyo, Japan
Sachiko Tanaka, PhD, RN
School of Nursing, The Jikei University, Tokyo, Japan
Keiko Ogawa, MA, CNM
Department of Maternal Nursing, Tokai University Junior College of Nursing and Technology, Kanagawa, Japan

Purpose: The purpose of this study is to examine the history of maternal and infant health in Japan by clarifying the administrative policies of the Japanese government from 1917 to present and the effect of these policies on the health of mothers and children education.

Methods: The historical research was conducted between August 1, 2012 and March 31, 2013. Sixteen semi-structured interviews were conducted with the past government officials responsible for health policies, related organizations, researchers, and specialists and relevant materials from respective institutions and libraries were examined. The research was approved by the ethics committees of the affiliated organizations.

Results: The modernization of Japan’s maternal and child health administration began from 1917, when the government cemented a policy based on scientific evidence and statistical research conducted by the Health Hygiene Investigation Committee. The Japanese maternal and child health system, which involved issuing maternity record books, providing health guidance through mass examination and home visits, and forging links with welfare systems, was produced by modeling after those of Germany and later enhanced by administrations in the period of U.S. occupation with the exception of the eugenic thought. Although in 1955 the Japanese government presented a policy that maternal and child health services by prefectural government will be provided by municipal in future, it failed to materialize due to issues related to human resources and technology; therefore, projects continued to be supported by non-government and community organizations. In mid 1970s, Japan was one of the nation which achieved the lowest rate of infant and maternal mortality in the world and were starting to aware of the limitations of a public hygiene approach based on improving these indicators. Then, from 1994, as national focus shifted to the aging population, and power became decentralized, and most of maternal and child health service were provided by municipal governments. Today, the maternal and child health service requires higher level ability which must also consider psychosocial dimensions of mothers and children. It faces challenges such as enhancing the ability of municipal public health nurses, establishing effective collaboration between prefectural and municipal public health nurses, promoting collaboration between national, local and municipal governments, local residents, and non-government organizations, and cultivating citizenship.

Conclusion: The administrative policies, outcomes and factors related to change maternal and child health in Japan are discussed. It contributed to achieve the lowest infant and maternal mortality in the past and is needed to tackle current challenges aging society with child birthrate falling and decentralization.